Radiation-Induced Cardiovascular Disease: Review of an Underrecognized Pathology

被引:119
|
作者
Belzile-Dugas, Eve [1 ,2 ]
Eisenberg, Mark J. [1 ,2 ,3 ,4 ]
机构
[1] McGill Univ, Lady Davis Inst, Jewish Gen Hosp, Div Clin Epidemiol, Montreal, PQ, Canada
[2] McGill Univ, Dept Med, Montreal, PQ, Canada
[3] McGill Univ, Dept Epidemiol Biostat & Occupat Hlth, Montreal, PQ, Canada
[4] McGill Univ, Jewish Gen Hosp, Div Cardiol, Montreal, PQ, Canada
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2021年 / 10卷 / 18期
关键词
cancer survivors; cardiomyopathies; cardiotoxicity; cardiovascular diseases; coronary artery disease; fibrosis; heart disease risk factors; CORONARY-ARTERY-DISEASE; INDUCED HEART-DISEASE; LONG-TERM SURVIVORS; MEDIASTINAL RADIATION; COMPUTED-TOMOGRAPHY; EXPERT CONSENSUS; CARDIAC-DISEASE; AORTIC-STENOSIS; CANCER-THERAPY; BREAST-CANCER;
D O I
10.1161/JAHA.121.021686
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Radiation therapy demonstrates a clear survival benefit in the treatment of several malignancies. However, cancer survivors can develop a wide array of cardiotoxic complications related to radiation. This pathology is often underrecognized by clinicians and there is little known on how to manage this population. Radiation causes fibrosis of all components of the heart and significantly increases the risk of coronary artery disease, cardiomyopathy, valvulopathy, arrhythmias, and pericardial disease. Physicians should treat other cardiovascular risk factors aggressively in this population and guidelines suggest obtaining regular imaging once symptomatology is established. Patients with radiation-induced cardiovascular disease tend to do worse than their traditional counterparts for the same interventions. However, there is a trend toward fewer complications and lower mortality with catheter-based rather than surgical approaches, likely because radiation makes these patients poor surgical candidates. When appropriate, these patients should be referred for percutaneous management of valvulopathy and coronary disease.
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页数:10
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